12725 (3)I — —
POST THIS CARD NEAR FRONT OF BUILDING
PERMIT NUMBER
CITY OF CUPERTINO 12725
INSPECTION DIVISION
IP � JOB INSPECTION RECORD
PERMIT EXPIRATION
JOBADDRESS 7485 PROSPECT ROAD UNIT# LOT#
PERMIT EXPIRES IF WORK
OWNER M/MM HOAGE CONTRACTOR HASSETT CONSTRUC IS NOT STARTED WITHIN
INSPECTION DATE INSPECTOR INSPECTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATION ANCE OR 180 DAYS FROM
UFER LASTCALLED INSPECTION.
PREGUNITE '
PERMIT VALIDATION
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SLAB
PLUMBING _ /I A
_ ELECTRICAL ISSUANCE DATE
MECHANICAL BIOG. ELECT, I PLG. MECH.
T ES! ❑ ❑ ❑
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT
INFORMATION
WOOD FLOOR VALUATION E/FT.
PLUMBING
MECHANICAL
ELECTRICAL PERMIT TO
FRAMING
STORIES TYPE CONSTR.
INSULATION
OCC.GROUP RES,UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
ROOF SO.FT,FLOORAREA TOTALACREAGE
DIAPHRAGM
BUILDING USE
NES IND CON PB Omer
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED ❑ ❑ ❑ ❑ ❑
ROUGH ASSESSORS PARCEL NO.
PLUMBING
GAS TEST TRACT NO. PARCEL NO.
1� V'(la (.Q v1n. y
MECHANICAL
ACC.DATE ACC.FILE NO.
ELECTRICAL FINALS DATE INSP.
FRAMING SAN ZONING, ENG.SITE NO.
INSULATION PLUMBING
GAS
FIRE SPRINK ENERGY L
MECHANICAL N
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ ❑ ❑
FLOOD ZONE A.LU,C.
' LATH-INTERIOR ELECTRICAL
LATH-EXTERIOR IRE DEPT. v❑ "❑ r ❑ "❑
SHEETROCK' G DE FEE SUMMARY
- SHEAR INTERIOR BUILDI
SHEAR EXTERIOR TEMPORARY APPROVALSBUILDING
FIREWALLS ELECTRIC PLAN CHECK
GAS FEE
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE
OCCUPANCYOF BUILDING IS NOTPERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION 'BY PHONING 252.4505, ELECTRIC
• F� ONE WORKING DAY BEFORE REQUIRED INSPECTION. PLUMBING
o PLEASE GIVE JOB ADDRESS WHEN PHONING.
Z MECHANICAL
- SEE PERMIT FOR EXPIRATION DATE -
IMPORTANT! . CONST.TAX
PLEASE READ REVERSE SIDE BEFORE TOTAL
CALLING FOR FINAL INSPECTION.
OFFICE COPY
APRLICANT TO FILL I INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BU LDING PROJECT I DENTI FICATION PERMIT NUMBER
aL,LGEN G APPLICATION & PERMIT
t ADDRESS "1X185 N� � 12725
. I � BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
OWNER'5 PLAN CHECK VALIDATION
NAME
Rmm-K ARBAR PHONE/ .qp CITY. ELECTRIC PERMIT FEE
PHONE
NCONTAMERACTOR'6 ny UTLETS-SWITCHES-RECEP 10.00/1.00
AT f L.C.NO. F/ ��p�A� LIGHTING FIXTURES 10.00/1.00
CONTRACTORS
crOns 74 `T APPLIANCES-RESIDENTIAL 4.00
AS
5 E� PHONE PANELS 10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.N0.
on PANELS (OVER 200 AMP) 20.00 �Z
ENGINEER
LIC.No. SIGNS TRANS. 3,00
ADDRESS ErvG' SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP TEMP.METER 08 POLE INS, 20.00
APPucANr's MOTORS SEE FEE SCH.
A DGRE65 nn / 1 .
$S $pQC7" KD. SERVICE CHANGE 20.00
woo LICENSED CONTRACTORS DECLARATION
<u I hereby affirm that I am licensed under provisions of Chapter 9 SSl7ANCE DATE
N<T (commencing with Section 7000)of Division 3 of the BusinessandBLDGN'ELECT. PLG. MECH.
r 7 i Professions Code,and my license is in full force and effect. El11 ❑
Z,O L- License Class Lic.Number
4 w Datc Contractor
¢ x s BUILDING PERMIT
¢ ¢w OWNER.BUILDER DECLARATION INFORMATION
E
0 AH 1 hereby affirm that I am exempt from the Contractor's License MISC.- REFER TO ORD
FLLOy ,VALUATION $/FT.
a Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 10.00
J Code:Anycity orcomay which mquiresa permit to construct,alter,
2 ¢ ¢ o improve,demolish,or repair any structure,prior to its issuance,also ELEC.CONTR. LIC.NO. ELEC.
aa
G S, Cult res the applicant for such permit t0 file a signed statement that TOTAL PERMIT TO
X $ he is licensed pursuant to the provisions of the Contractor's License
Fzi
Law(Chapter 9(commencing with Section 7000)of Division 3 of the TllJu h/
a Business and Professions Code)or that he is exempt therefrom and CITY. PLUMBING PERMIT FEE
¢ r thehasis for file alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
w. by any applicant for a permit subjects the applicant In a civil Penalty gLTER-DRAIN -WATER (EA.) 5.00
of not mom than five hundred dollars(S500).):
❑ I,as owner of the property,or my employees with wages as BACK FLOW PROTECT. DEVICE 4.00 OCC.GROUP RES.UNITS
their sole compensation,will do the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
Code:The Contractor's License Law does not apply to an owner of
. property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 SO.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees,provided that such improve GAS-EA.SYSTEM-1 INC.40UTLETS 6.00
mems are not intended m offered for sale.If,however,the building
or improvement is sold within one year of completion,the owner- GAS-EASYSTEM-OVER 4 IEA) 200
builder will have the burden of proving that he did not build or ins- . . .
BUILDING USE
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Orbe,
❑ as owner of the property,am exclusively contracting with El ❑ El El
licensedd contractors to construct the project7044.Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
La
and Professions Code:The Contractor's License Law Joos not apply
to anowner of property who builds improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)
actors)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractor's License Law. TRACT NO. PARCEL NO.
❑ l am exempt under Sec. ,BAP.C.for it,is WATER HEATER W/VENT 6.00
naso
Own Dam WL71-'7 WATER SYSTEM 5.00
ACC.DATE ACC.FILE NO,
WORKERS'COMPENSATION D'.CLARATION WATER TREATING EQUIP. 5.00
11lerehy affirm that I have o certificate of conseol in self-insure' ZONING
or a cn'lificate of Workers'Compensation Insurance,ora certified ENG.SITE NO.
copy Otereof(Sce.3800,LaDCA
Policy No. Company
O ❑ Certified Copy is hereby furnished. FIRE$PRINK ENERGY T 24
_z Z ❑ Certified copy is filed with the city inspection division, MISC.- REFER TO ORD.
V Applicant Y ❑ N❑ Y.C] N❑
I- y PERMIT ISSUANCE 10,00 FLOOD ZONE A.L.U.C.
LU - CIiRTII°ICATIi 1:EXEMPTION INS FROM WORKERS'
W � COMPIiNSATION INSURANCE PLG.CONTR. LIC.NO. PLG.
0-• o (This section need nor be completed if the permit is for one TOTAL Y❑ N❑ Y❑ N❑
0 Z hundred dollars IS 100)or less.)
L.) O 1 certify that in the performance of the work for which this per- CITY. MECHANICAL PERMIT FEE FEE SUMMARY
U. F- mil is issued,1 shall not employ any person in any manner so as to
V become subject to the Workers'Compensation Laws of California.
W Dam BUILDING
C. - Applicant ALTER OR ADD TO MECH. 5.00
} In NOTICE TO APPLICANT: If,after making this Certificate of fix
{- 2 emption,you should become subject to the Workers'Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with FEE
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=C.F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=1 .FM.) 6.00 SEISMIC FEE
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM ,
3097,Civ.C.), HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name HEATING UNIT(OVER 100,000 B.T.U.)Lender's Name ELECTRIC
I certify that I have read this application and stale Little above VENTILATION FAN (SINGLE) 4.00
information is correct. I agree to comply with all eily and county PLUMBING
ordinances and state laws relating to building construction, and BOILER-COMP"H.P.or 100,000 B.T.U.) 6.00
hereby authorize representatives ec this city a enter upon the BOF LER-COMP IOver 100.000 BTU.)SEE FEE SCH. MECHANICAL
above-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of MISC..- REFER TO ORD.
Cupertino against liabilities,judgments, costs and expenses which CONST.TAX
Elf, ,
any ay accrue ago' st said City in consequence of the PERMIT ISSUANCE 10.00
Elfin of lhisw..in MECH.CONT. LIC.NO. MECH. /
TOTAL TOTAL
lgnamm of Applican/Contractor Dane
OFFICE COPY